Hisato Osada

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy

PurposeThe importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy.Materials and methodsThe subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy.ResultsThe QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score.ConclusionWe could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.

Imaging of Ventilation with Dual-Energy CT during Breath Hold after Single Vital-Capacity Inspiration of Stable Xenon

PURPOSE To assess single-breath-hold technique for ventilation mapping by using dual-energy computed tomography (CT) in phantom experiments and volunteers. MATERIALS AND METHODS Institutional review board approved this study, and written informed consent was obtained from all volunteers. A rubber bag filled with a mixture of xenon (0%-35.4%) and oxygen was scanned with dual-source dual-energy CT (80 kV and 140 kV with tin [Sn] filter [Sn/140 kV] and 100 kV and Sn/140 kV). A cylinder containing six tubes of identical sizes with different apertures was ventilated once with a mixture of 35% xenon and 65% oxygen and was scanned in dual-energy mode (80 kV and Sn/140 kV). Xenon-enhanced images were derived by using three-material decomposition technique. Four volunteers were scanned twice in dual-energy mode (80 kV and Sn/140 kV) during breath hold after a single vital-capacity inspiration of air (nonenhanced) and of 35% xenon. Xenon-enhanced images were obtained by using two methods: three-material decomposition and subtraction of nonenhanced from xenon-enhanced images. Regression analysis with t and F tests was applied to the data of the rubber bag scans, with the significance level set at .05. RESULTS Mean pixel values of gas in the bag were linearly related to xenon concentration for all x-ray tube voltages (r(2) = 1.00, P < .00001). Pixel values of the xenon-enhanced images of the tubes were related to their aperture size. Nearly homogeneous (coefficient of variation: 0.22, 0.23, and 0.34) pixel values were found in the lungs of healthy volunteers, with higher pixel values in the trachea and lower pixel values in the bullae. Xenon-enhanced images calculated by using three-material decomposition had better image quality on visual comparison than those calculated by using subtraction. CONCLUSION Xenon-enhanced dual-energy CT with the single-breath-hold technique could depict ventilation in phantoms and in four volunteers.

Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stonestreet formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm.

Abstract:  The incidence of stonestreet formation after extracorporeal shock wave lithotripsy (ESWL) rises with increasing stone burden. However, stonestreet after ESWL is often experienced even in stones smaller than 20 mm. To examine whether the non‐contrast helical computed tomography (CT) data could predict stonestreet formation in these stones, 53 radiopaque stones of 5–20 mm treated with ESWL were evaluated. Maximal dimension was measured on plain radiograph. From an attenuation value histogram graphed from the CT data, total stone volume and mean attenuation value were calculated. Seven stonestreets longer than 25 mm developed. There was no significant difference in maximal dimension and total stone volume between stones that did and stones that did not develop stonestreet. Mean attenuation value was the sole significant predictive factor. Application of mean attenuation value with cut‐off level of 650 HU would anticipate stonestreet formation with a sensitivity of 85.7% and a specificity of 71.7%. The estimated risk of stonestreet formation is high in the treatment of stones with higher mean attenuation value.

Three-dimensional vascular anatomy relevant to oncologic resection of right colon cancer.

We analyzed data on the three-dimensional vascular anatomy of the right colon from the operative documents of 215 patients undergoing oncologic resection for right colon cancer. The right colic artery (RCA) was absent in 146 patients (67.9%), with the ileocolic artery (ICA) crossing the superior mesenteric vein (SMV) ventrally in 78 patients (36.3%). When the RCA was present, both the ICA and the RCA crossed the SMV ventrally in 44 patients (20.5%), dorsally in 10 patients (4.7%), the RCA crossed the SMV ventrally and the ICA dorsally in 10 patients (4.7%), and the RCA crossed the SMV dorsally and the ICA ventrally in 5 patients (2.2%). The arterial branches toward the hepatic flexure crossed the SMV ventrally in 151 eligible cases: the branch originated from the common trunk of the middle colic artery in 97 patients (64.2%) and 1 and 2 arteries directly originated from the SMA in 49 patients (32.5%) and in 5 patients (3.3%), respectively. These data would be useful to safely perform lymph node dissection around the SMV.

Diagnostic accuracy of multidetector-row computed tomography for hilar cholangiocarcinoma.

Background and Aim:  The aim of this study was to investigate the diagnostic reliability of multidetector‐row computed tomography (MDCT) for the evaluation of tumor spread in hilar cholangiocarcinoma.

Relation between pulmonary embolus volume quantified by multidetector computed tomography and clinical status and outcome for patients with acute pulmonary embolism

PurposeThe aim of this study was to determine whether pulmonary embolus volume (PEV) obtained with multi-detector row computed tomography is related to clinical status and outcomes.Materials and methodsSubjects comprised 48 patients with acute pulmonary embolism (PTE). PEV was measured by tracing the contours manually and compared between sets of two groups divided by clinical status. Correlations of PEV to blood gases and D-dimer levels were investigated. PEV was tested as a predictor of clinical probability of acute PTE using Wells’ criteria and as a predictor of survival after PTE by logistic regression analysis.ResultsThe PEV was greater in groups with respiratory symptoms (P < 0.001), PTE as pretest clinical diagnosis (P = 0.027), and heart rate >100 beats/min (P < 0.001). It was smaller in subjects with concurrent malignancy (P = 0.02). It was correlated with PaCO2 (P = 0.04, ρ = −0.37) and the D-dimer level (P = 0.002, ρ = 0.46); it was not a predictor of clinical probability of acute PTE or survival after PTE. The survival rate did not differ between groups with PEV > 10 ml (8/9) or ≤10 ml (32/36).ConclusionThe PEV in acute PTE may relate to the presence of respiratory symptoms, hypocapnia, and tachycardia. The PEV was smaller in patients with malignancy. It did not contribute to mortality in this study.

Appendiceal diverticulitis: multidetector CT features

PurposeAppendiceal diverticulitis has been difficult to distinguish from acute appendicitis clinically and radiologically. The purpose of this study was to describe multidetector computed tomography (MDCT) features of cases of pathologically proved appendiceal diverticulitis at our institution over a 36-month period.Materials and methodsSeven of 156 patients who underwent appendectomy with the preoperative diagnosis of acute appendicitis were pathologically diagnosed with appendiceal diverticulitis. Two radiologists reviewed the MDCT images for these 7 patients.ResultsOn MDCT, a total of 8 inflamed diverticula were visualized as small fluid-filled luminal structures with thick enhanced walls or as solid enhanced masses protruding from the appendix for 6 of 7 patients. For 2 of these 6 patients, MDCT revealed a total of 5 normal diverticula visualized as small air-filled luminal structures with thin walls. For 1 of the 7 patients, neither inflamed or normal diverticula could be identified on MDCT. MDCT revealed appendiceal wall thickening with a tiny or no luminal fluid collection for 5 patients and with a moderate fluid collection for 1 patient, and a normal appendiceal wall for 1 patient.ConclusionOur results suggest that MDCT can reveal appendiceal diverticula and has potential in the preoperative diagnosis of appendiceal diverticulitis.

Quantitative lung perfusion scintigraphy and detection of intrapulmonary shunt in liver cirrhosis

Objective: Frequent association between liver cirrhosis and hypoxemia has been well documented. It is mostly attributable to intrapulmonary shunt due to dilation of pulmonary vasculature. We performed quantitative lung perfusion scintigraphy to detect an intrapulmonary shunt in cirrhosis patients.Methods: Prior to injection, Tc-99m MAA was applied to thin layer chromatography for quality control. Three cirrhosis patients who had hypoxemia were examined as well as 11 control subjects. After i.v. injection of Tc-99m MAA, whole body anterior and posterior images were taken at 5 min in patients with cirrhosis and at 8 time points up to 60 min in control subjects. Regions of interest were placed at the bilateral lungs and the whole body, and pulmonary accumulation was calculated.Results: All the control subjects demonstrated more than 90% of radioactivity in the lungs until 20 min. In contrast, all the patients showed values less than 80% at 5 min. In the cirrhosis patients with hypoxemia, the presence of intrapulmonary shunt was confirmed on quantitative lung perfusion scan. In control subjects, pulmonary accumulation of Tc-99m MAA dropped as a function of time and became less than 90% after 30 min.Conclusion: The timing, of measurements is essential in evaluating intrapulmonary shunt.

Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands

Adhesive small bowel obstruction (SBO) is a common cause of abdominal pain after surgery or peritonitis. The role of computed tomography (CT) in the evaluation of SBO has expanded. Diagnosis of adhesive SBO, however, remains challenging. Adhesions causing SBO are classified as either matted adhesions or single adhesive bands, and both types have different mechanisms that lead to SBO. In patients with matted adhesions, SBO results from angulation and kinking or from torsion of the intestines. In patients with adhesive bands, SBO results from compression of the intestine caused by the band itself. Recent advances in spatial resolution using multidetector CT (MDCT) have enabled detailed assessment of the configuration of the SBO site. Presented in this pictorial essay are characteristic MDCT findings regarding the mechanism of the obstruction process of adhesive SBO.

Bilateral renal angiomyolipoma coexistent with pulmonary lymphangioleiomyomatosis and tuberous sclerosis

A case of bilateral renal angiomyolipoma coexistent with pulmonary lymphangioleiomyomatosis and tuberous sclerosis was described, being in shock with massive hematuria. The left giant angiomyolipoma, filling the almost entire abdomen, was complicated with two large hump and moniliform aneurysms. This life-threatening hemorrhage was successfully treated by transcatheter arterial embolization; packing mechanically detachable coils into the aneurysms and embolization of trunk of the left renal artery. Lymphangioleiomyomatosis has been suggested to be an incomplete expression of tuberous sclerosis. Although coexisting renal and pulmonary involvement in tuberous sclerosis is rare, it is important to recognize lymphangioleiomyomatosis as a pulmonary involvement of angiomyolipoma with tuberous sclerosis.